Each year, during Eating Disorders Awareness Week, articles flood the internet covering topics such as anorexia, bulimia, and binge-eating. These articles often include the latest prevalence data, symptoms to watch for, differences between types and diagnoses, specific treatments, and resources for further information, and most of these are primarily geared toward girls.
The stereotype of young girls starving themselves to be skinny, the outcry over unrealistic portrayals and false body images on social media, and the concern over the rise in eating disorders among children aged 12–18 mostly focus on girls and women, often overlooking the growing prevalence of eating disorders among boys and men.
Suffering in Silence
The well-known eating disorders (EDs), such as bulimia nervosa, anorexia nervosa, and binge-eating disorder, are more commonly associated with females. However, males are increasingly affected, with studies showing that 1 in 3 people diagnosed with an eating disorder are male. Yet, because the disorder often goes undiagnosed, many boys suffer in silence.
Stigma, misconceptions, and societal stereotypes contribute to the lack of awareness, hindering diagnosis and leaving many boys struggling.
How Prevalent are Eating Disorders in Boys?
Similar to girls, eating disorders amongst boys include anorexia, bulimia, and binge-eating. But other behaviors including disordered eating patterns (those that occur outside the traditional diagnoses) such as body image disturbances, unhealthy weight or shape control behaviors, or loss of control over eating are occurring in boys at a faster rate than in girls. A 2023 study confirmed that boys experience ARFID, an extreme sensitivity to and restriction of foods, equally as often as girls. And muscle dysmorphia – an obsession with becoming more muscular – occurs more often in males. In fact, by ages 16 to 25, almost 25% of boys have expressed concern about their muscularity, and 11% have used muscle-enhancing substances such as steroids or supplements.
Causes
The factors that contribute to eating disorders are complex with biological, psychological, and environmental factors coming into play. Just like girls, boys with eating disorders are dissatisfied with their body image. Yet here is where they diverge – most girls aspire to be thinner, to fit into size “0” jeans or “lose 10 pounds” while boys aspire to have low body fat and are driven to be more muscular – a condition frequently referred to as “bigorexia” or muscle dysmorphia.
The Role of Society and the Media
Cultural and societal ideals of the ‘perfect male body’ have existed for centuries. Not much has changed since the Renaissance, when Michelangelo carved Florence’s ‘David’ statue depicting the perfectly chiseled, muscular male figure. Actors who are as famous for their physiques as they are for their acting ability perpetuate the concept of an ‘ideal male body,’ influencing boys’ perceptions of their bodies and themselves. Professional athletes are revered in our society – their muscular physiques inextricably linked to fame and high salaries. An entire industry is devoted to high protein foods and powders, extreme fitness routines, and the concept of “bulking up” to help boys appear more “manly.”
Challenges in Diagnosis
Eating disorders begin to appear in both girls and boys with the onset of adolescence. Peer influence and comparison to others take center stage and parental guidance begins to matter less and less. This timing contributes to challenges in diagnosis. First, eating disorders present differently in boys. While girls often focus on weight loss, boys may pursue ‘leanness’ or ‘muscle definition,’ which, without significant changes, might simply appear as a typical aspect of male puberty. Second, this is the time that many boys begin to play sports. Exercising to excess, strict diets, and obsession with protein consumption make perfect sense for a boy involved in weight-sensitive sports like wrestling, gymnastics, or bodybuilding, thus failing to raise any red flags. Finally, boys face a stigma that prevents them from seeking help. Since eating disorders are so closely associated with girls, boys may fear judgement and ridicule if they seek help. Even when they do reach out for help, healthcare providers may misattribute their symptoms further delaying diagnosis and treatment.
Symptoms of Eating Disorders in Boys
Recognizing the signs of eating disorders in boys can be challenging since every person and situation is unique. However, knowing and recognizing the warning signs is crucial for early intervention. Here are some signs to look out for:
- Compulsive Exercise: Spending long hours in the gym or expressing feelings of anxiety when unable to exercise.
- Overly Restrictive Eating: Refusing entire food groups, following rigid food rules or obsessively weighing food, counting calories or fat content, etc.
- Heightened Focus on Gaining Muscle: Adhering to strict high protein diets, overuse of protein powders and supplements, using steroids
- Atypical Eating Habits: Eating at odd times or avoiding meals, cutting food into pieces or eating in isolated places, e.g. in their rooms at home, in the guidance counselor’s office, or in the bathroom at school
- Obsessed with their Body: Constant talk about their bodies and issues surrounding their bodies, frequently checking weight, frequently expressing concern about body shape, etc.
- Mental Health Issues: Presenting with comorbid conditions such as anxiety, stress, depression, or irritability
- Physical Symptoms: Losing weight quickly or in large amounts, changes in muscle mass, growth problems, less energy
The Impact of Eating Disorders on Boys
Eating disorders that go untreated can have severe physical and psychological impact on boys. EDs can cause serious medical concerns that can be irreversible including impaired growth, developmental delays, or reductions in bone density acquisition. Compulsive exercise can lead to injuries, placing strain on young muscles and joints, and can also affect cardiovascular health. The use of supplements or steroids can cause high blood pressure, liver damage, and hormonal imbalances.
Eating disorders also contribute to mental health challenges in boys including anxiety, depression, and suicidal ideation.
The Road to Recovery
The treatment for eating disorders for boys is similar to girls and fortunately boys respond equally well to evidence-based treatments. These include:
- Cognitive-Behavioral Therapy (CBT): A treatment that helps patients challenge unhealthy perceptions and behaviors around eating and to develop healthy coping skills
- Nutrition Counseling: Provides education and helps develop skills and plans to support healthy eating habits
- Individual, Family, and Group Therapy: Includes parents and caregivers to support boys in their recovery
How to Raise Awareness and Reduce Stigma
Protecting our boys is so important. For too long society has worshipped a male physique that is unattainable, unhealthy and, quite frankly, unnecessary for boys to lead happy and successful personal and professional lives.
How can we open a dialogue about boys’ body image? Healthcare providers and educators can launch educational campaigns geared toward boys, particularly young athletes that challenge these misconceptions and provide resources. Educators and schools can invite survivors to speak at board meetings, assemblies, or events. Parents, caregivers, teachers, and coaches can encourage boys to discuss their insecurities and seek help.
Eating disorders in boys are far more prevalent than we once thought. It’s up to all of us to recognize the signs and symptoms of eating disorders in boys, not just girls, so that all children feel supported and understood, knowing that seeking help is a sign of strength, not weakness. Finally, as a society, we should temper our expectations of what is considered ‘manly’ and ‘perfect,’ understanding that our past ideals may be harming boys in ways we never anticipated and certainly don’t want.
Resources
https://www.apa.org/monitor/2024/10/eating-disorders-boys-men
https://www.nationaleatingdisorders.org/
https://childmind.org/article/boys-and-eating-disorders/
